Sci Transl Med:超声波成为胎盘疾病中阻断缺陷血管的工具

日期：2016-07-14 期刊：Science Translational Medicine

DOI：10.1126/scitranslmed.aaf2135 作者：Caroline J. Shaw

2016年7月13日，国际顶尖学术期刊《Science》旗下《 Science Translational Medicine》杂志上在线发表英国剑桥大学Caroline J. Shaw研究员的一篇研究论文，研究人员在羊体内所做的新的研究显示，超声波可能成为用于分开影响某些双胎妊娠的胎盘异常血管的新工具。经过进一步的研发，这项技术或能成为一种创伤较小及可能更为安全的双胎输血综合征的替代疗法;该综合征颇为罕见，但它对某些共有同一胎盘的同卵双胎妊娠却是致命的并发症。在这一疾病中，孪生胎儿间形成了异常血管连接，导致胎儿血供分配不平等。目前使用的摧毁连接血管的创伤性激光手术常常无效而且危险，因此该方法被留用于治疗严重病例。Caroline Shaw和同事寻求用高强度聚焦超声来消融正常妊娠羊体内的胎盘血管。当被置于子宫表面时，超声波成功地封堵了胎盘血管且并发症很少。母羊和羊宝宝都未受伤害，通往胎儿脑部的血流保持正常。这些结果表明，该超声波技术或能进一步地被用来治疗TTTS及可能的相关妊娠病症。

胎盘血管消融的彩色多普勒和B型超声显像。(A)胎盘及其附属物的治疗前彩色多普勒成像。(B)显示靶血管内没有血流的同一胎盘及其附属物的治疗后彩色多普勒成像。(C)高强度聚焦超声(HIFU)聚焦区域内的高回声区B型谐波超声成像。

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原文摘要：

We investigated the efficacy, maternofetal responses, and safety of using high-intensity focused ultrasound (HIFU) for noninvasive occlusion of placental vasculature compared to sham treatment in anesthetized pregnant sheep. This technique for noninvasive occlusion of placental vasculature may be translatable to the treatment of conditions arising from abnormal placental vasculature, such as twin-twin transfusion syndrome (TTTS). Eleven pregnant sheep were instrumented with maternal and fetal arterial catheters and time-transit flow probes to monitor cardiovascular, acid-base, and metabolic status, and then exposed to HIFU (n = 5) or sham (n = 6) ablation of placental vasculature through the exposed uterine surface. Placental vascular flow was occluded in 28 of 30 targets, and histological examination confirmed occlusion in 24 of 30 targets. In both HIFU and sham exposures, uterine contact reduced maternal uterine artery flow, but delivery of oxygen and glucose to the fetal brain remained normal. HIFU can consistently occlude in vivo placental vessels and ablate blood flow in a pregnant sheep model. Cardiovascular and metabolic fetal responses suggest that the technique is safe in the short term and potentially translatable to human pregnancy.